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Home My WebLink About2014-09-02 CorrespondenceUnderstanding Electronic Cigarettes Johnson County Public Health Department J a Public Health r■ The Makings of an E- cigarette) ■ Generally battery operated ■ Uses an atomizer to heat a refillable cartridge thereby releasing a chemical filled vapor ■ Allows users to inhale a vapor containing nicotine and /or other substances Inside of Electronic Cigarette LED Smart Lithium Ion Cartridge blu Chip Battery Controller Fj The vapor is created by 1 Atomizer heats the eliquid Heating Vapor Cell Flavor liquid or eliquid Silicone Tip What we do know ■ Not regulated by the FDA yet ■ Contain varying amounts of nicotine ■ They contain volatile organic compounds (VOCs) that are NOT healthy for human inhalation ■ Marketing tactics and flavorings show an attempt to lure youth ■ No evidence that using e- cigarettes or being exposed to the vapor is safe ■ The 3 largest tobacco companies (Lorillard, RJ Reynolds and Philip Morris) have purchased or developed products ■ Use of e- cigarettes among middle and high school students has more than doubled ■ Can undo decades of public health work in tobacco control Around the U.S. many are prohibiting e- cigarettes where traditional cigarette use is banned. ■North Dakota, New Jersey, Utah - state laws restricting use ■ 188 municipalities, as of July 2014, have restrictions. More are being passed weekly. NO SMOKING INCLUDING E- CIGARETTES 0 E- cigarettes look very similar to real cigarettes (especially from a distance) _ enforcement problems The vapor emitted could potentially irritate non - smokers and pose a health risk Allowing e- cigarette use may facilitate real cigarette use to "slip through the cracks" There may be environmental and health issues to using e- cigarettes indoors and in areas with minimal air circulation r■ Smokefree Policies & E- Cigarettes ■ It is legal to prohibit e- cigarette use in your facility /business ■ Businesses may want to revise their current policies to include e- cigarette use as a form of smoking ■ A ban stating such use should specify that smoking in any form or vaping an e- cigarette is prohibited ■ This eliminates confusion and establishes a smoke -free environment Up to the same old tricks 4 �Jj L1 om I - a� - J �"I , !ithout the guilt. �' REA Y i0 G0. AV .► Vn{.or S'J'b C C.y,," B. t,.jrJ [ o•Jj '�I: o isvosneLe E- unvouaisees OL/cvu /n FmM Vanilla CO F0. Contact Information Douglas Beardsley, MPH- Director dbeardsley@co.johnson.ia.us (319) 356 -6040 Susan Vileta, Health Educator svileta@co.johnson.ia.us (319) 356 -6040 x5910 IN References i. U.S. Food and Drug Administration. "FDA Warns of Health Risks Posed by E- Cigarettes." July 23, 2009. Available at: http:// www. fda. gov/ ForConsumers /ConsumerUpdates /ucm 173401.htm. z. US Patent 3200819. Smokeless non - tobacco cigarette ". Retrieved July 7, 2014. 3. A high -tech approach to getting a nicotine fix, Los Angeles Times a. U.S. Electronic Cigarette Statistics [Infographic]. Accessed on 7/10/14 from: http: / /blog. misticecigs. com /electronic- cigarettes -us -info graphic s. "Nicotine (PIM) ". Inchem.org. Retrieved July 7, 2014 s. Genetic Science Learning Center. "How Drugs Can Kill ". z. Mayer B (October 2013). "How much nicotine kills a human? Tracing back the generally accepted lethal dose to dubious self- experiments in the nineteenth century". Arch. Toxicol. 88 (1):5- 7.doi:10.1007 /s00204- 013 - 1127 -0. s. McAuley, T. R., Hopke, P. K., Zhao, J., & Babaian, S. (2012). Comparison of the effects of e- cigarette vapor and cigarette smoke on indoor air quality. Inhalation toxicology, 24(12),850-857. s. Schripp, T., Markewitz, D., Uhde, E., & Salthammer, T. (2013). Does e- cigarette consumption cause passive vaping ?. Indoor Air, 23(1), 25 -31. 10. FDA (4 May 2009). "FDA 2009 Study Data: Evaluation of e- cigarettes ". Food and Drug Administration (US) - center for drug evaluation and research. Retrieved 4 May 2009. Electronic Cigarettes: What the Research Tells Us • Given the growing evidence that the vapors produced by ENDS contain nicotine, benzene, cadmium, formaldehyde, isoprene, toluene, and other potentially harmful chemicals, including ENDS use under state and local policies prohibiting smoking in workplaces, restaurants, bars, and other public places would be an important step in protecting nonusers from exposure to secondhand vapors. Chaloupka, F. Tobacco Control Policy and Electronic Cigarettes. Published Online: March 6, 2014. doi:10.1001 /j amapediatrics.2014.349. • The e- cigarette is a new source of VOCs (Volatile Organic Compounds) and ultrafine /fine particles (FP/UFP) in the indoor environment. • E- cigarettes release numerous detectable levels of several significant carcinogens and toxins compounds into the "indoor environment ". • E- cigarettes users not only ingest, but also emit toxins and harmful ultrafine and fine particles, posing potential health risks to those nearby. • Selected compounds that are also present in the second hand smoke of regular cigarettes include the following: 1, 2- Propanediol ,l - Hydroxy -2- propanone, 2,3- Butanedione, 2,5- Dimethylfuran, 2- Butanone (MEK), 2- Furaldehyde, 2- Methylfurane, 3- Ethenyl- pyridine, Toluene, Acetaldehyde, Acetic acid, Acetone, Benzene, Isoprene, Limonene, m, p- Xylene, Phenol, Pyrrole, Formaldehyde, and Propanal. Schripp T, Markewitz D, Uhde E, Salthammer T. Does e- cigarette consumption cause passive vaping? Indoor Air. 2013;23(1):25. • In initial lab tests conducted in 2009, FDA found detectable levels of toxic cancer - causing chemicals, including an ingredient used in anti - freeze, in two leading brands of e- cigarettes and 18 various cartridges. • Impurities found in tobacco which are suspected of causing adverse health effects were also detected, including anabasine, myosmine, and (3- nicotyrine. • The lab tests also found that cartridges labeled as nicotine -free had traceable levels of nicotine. • A study has found out that the nicotine content of the studied ECs' liquids varied and was 1.2 -fold higher than what the manufacturer claimed. • There is no evidence that shows the vapors emitted by e- cigarettes are safe for non -users to inhale. Schober W, Szendrei K, Matzen W, et al. Use of electronic cigarettes (e- cigarettes) impairs indoor air quality and increases FeNO levels of e- cigarette consumers. Int J Hyg Environ Health. (0). U.S. Food and Drug Admin., Summary of Results: Laboratory Analysis of Electronic Cigarettes Conducted by FDA, Public Health Focus, FDA.GOV (July 22, 2009), h gp://www. fda. ov/ NewEvents/ PublicHealthFocus /ucm173146.htm. Regarding inhalation, a Master Data Safety Sheet, guidance for the industrial use of propylene glycol by Sciencelab.com, Inc., states it can cause eye and respiratory irritation and "Prolonged or repeated inhalation may affect behavior /CNS (with symptoms similar to ingestion), and spleen. "(Sciencelab.com Inc., 2013)A major manufacturer of propylene glycol, the Dow Chemical Company, states in its product safety materials that the "inhalation exposure to [propylene glycol] mists should be avoided "(Dow Chemical Company, 2013) and the American Chemistry Council warns against its use in theater fogs due to its potential to cause eye and respiratory irritation.(The American Chemistry Council, July 200 1) When heated and vaporized, propylene glycol can form propylene oxide, an IARC class 2B carcinogen.(Laino T etal., 2012) and glycerol forms acrolein, which can cause upper respiratory tract irritation.(U.S. EPA, Henderson TR et al., 198 1) • Studies have detected varying levels of nicotine content from labeled amounts, and the presence of volatile organic compounds, tobacco - related carcinogens, metals and chemicals. Some of the chemicals, particularly some flavoring agents, in e- cigarette aerosol are cytotoxic to human and rat cells, particularly human embryonic cells. Several chemicals that have been found in e- cigarette aerosol and e- liquid are on California's official list of known human carcinogens or reproductive toxicants, including nicotine, acetaldehyde, formaldehyde, nickel, lead, toluene. • Claims that nicotine is harmless are not supported by the scientific evidence as summarized in the 1988 Surgeon General's Report on The Health Consequences of Smoking: Nicotine Addiction. • Nonsmokers (persons who do not use tobacco cigarettes or e- cigarettes) who are exposed to the exhaled, or secondhand, e- cigarette aerosol have measurable levels of the nicotine metabolite cotinine in their blood. Grana, R, Benowitz, N, Glantz, S. Background Paper on E- Cigarettes Center for Tobacco Control Research and Education, University of California, San Francisco & WHO Collaborating Center on Tobacco Control. Prepared for World Health Organization Tobacco Free Initiative, December 2013. http://escholarship.org/uc/item/1 3p2b72n • E- cigarettes deliver nicotine by creating an aerosol of ultrafine particles. Fine particles can be variable and chemically complex, and the specific components responsible for toxicity and the relative importance of particle size and particle composition are generally not known. • Given these uncertainties, it is not clear whether the ultrafine particles delivered by e- cigarettes have health effects and toxicity similar to the ambient fine particles generated by conventional cigarette smoke or secondhand smoke. There is strong evidence, however, that frequent low or short-term levels of exposure to fine and ultrafine particles from tobacco smoke or air pollution can contribute to pulmonary and systemic inflammatory processes and increase the risk of cardiovascular and respiratory disease and death. Secondhand Smoke Exposure and Cardiovascular Effects: Making Sense of the Evidence. Washington, DC: Institute of Medicine; 2010. Brook RD, Rajagopalan S, Pope CA, Brook JR, Bhatnagar A, Diez -Roux AV, Holguin F, Hong Y, Luepker RV, Mittleman MA. Particulate matter air pollution and cardiovascular disease: an update to the scientific statement from the American Heart Association. Circulation. 2010;121:2331 -2378. Pope CA 3rd., Burnett RT, Krewski D, Jerrett M, Shi Y, Calle EE, Thun MJ. Cardiovascular mortality and exposure to airborne fine particulate matter and cigarette smoke: shape of the exposure- response relationship. Circulation. 2009;120:941 -948. Mehta S, Shin H, Burnett R, North T, Cohen AJ. Ambient particulate air pollution and acute lower respiratory infections: a systematic review and implications for estimating the global burden of disease. Air Qual Atmos Health. 2013:1 -15. Google Scholar • Although data are limited, it is clear that e- cigarette emissions are not merely "harmless water vapor," as is frequently claimed, and can be a source of indoor air pollution. Smoke -free policies protect nonsmokers from exposure to toxins and encourage smoking cessation. • One hundred percent smoke -free policies have larger effects on consumption and smoking prevalence, as well as hospital admissions for myocardial infarction, stroke, and other cardiovascular and pulmonary emergencies, than weaker policies. Introducing e- cigarettes into clean air environments may result in population harm if use of the product reinforces the act of smoking as socially acceptable or if use undermines the benefits of smoke -free policies. US Department of Health and Human Services. The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General Washington, DC: Department of Health and Human Services PHS, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office of Smoking and Health; 2006. Fichtenberg CM, Glantz SA. Effect of smoke -free workplaces on smoking behaviour: systematic review. BMJ. 2002;325:188. 126.0 Tan CE, Glantz SA. Association between smoke -free legislation and hospitalizations for cardiac, cerebrovascular, and respiratory diseases: a meta - analysis. Circulation. 2012;126:2177 -2183. • According to a CDC study published in the journal Nicotine and Tobacco Research, yhe number of youth who used electronic cigarettes (e- cigarettes) was 79,000 in 2011, and was more than three times higher in 2013 at 263,000. • This data, which comes from the 2011, 2012, and 2013 National Youth Tobacco surveys of middle and high school students, show that youth who had never smoked conventional cigarettes but who used e- cigarettes were almost twice as likely to intend to smoke conventional cigarettes as those who had never used e- cigarettes. Among non - smoking youth who had ever used e- cigarettes, 43.9 percent said they intended to smoke conventional cigarettes within the next year, compared with 21.5 percent of those who had never used e- cigarettes Rebecca E. Bunnell, Israel T. Agaku, Rene Arrazola, Benjamin J. Apelberg, Ralph S. Caraballo, Catherine G. Corey, Blair Coleman, Shanta R. Dube, and Brian A. King. Intentions to smoke cigarettes among never - smoking U.S. middle and high school electronic cigarette users, National Youth Tobacco Survey, 2011 -2013. Alleviate the risk of confusion There are many reasons why banning e- cigarette use in your facility is a good idea: • E- cigarettes can appear identical to tobacco cigarettes, so enforcement would be difficult • Inclusion of e- cigarettes under current smokefree laws guarantees a smokefree environment Creates peace of mind Can you tell the difference? 6 For more info E- cigarettes: Contact us at (319) 356 -60 and ask for one c Health & Human Se 855 S Dubuque St Suite 217 Iowa City, IA 52240 Johnson County Public Health Johnson County Public Health What you need to know! What are e- cigarettes? E- cigarettes (also known as electronic cigarettes or vaporizers) are devices designed to simulate the experience of conventional cigarettes. These devices are often battery- operated and deliver nicotine and flavorings without the burning mechanism of conventional cigarettes. An e- cigarette produces a vapor that resembles cigarette smoke. is e- cigarette vapor harmless? f11- Quick facts about e- cigarettes They are ': FDA regulated fop, Nicotine levels listed on e- cigarettes are always accurate E- cigarette use MAY —_ be a gateway to nicotine addiction The jury is still out regarding the Until more is known about the long -term effects of \,,,y \.7 safety of secondhand e- cigarette secondhand vapor, it is best to treat e- cigarettes like vapor. No evidence shows that conventional cigarettes. This protects non - smokers NO SMOKING this vapor is saf e for inhalation by from potential risk. E -cigarettes can be included INCLUDING non-smokers. existing smokefre regulations. E- CIGARETTES